902 KAR 20:430. Facilities specifications, operation and services; behavioral health services organizations

Link to law: http://www.lrc.ky.gov/kar/902/020/430.htm
Published: 2015

      902 KAR 20:430. Facilities specifications, operation and

services; behavioral health services organizations.

 

      RELATES

TO: KRS 17.500, 198B.260, 200.503(2), 210.005(2), (3), 216B.050, 216B.105, 309.080,

309.130, 311.860, 314.042, 319.050, 319.056, 319.064, 319C.010, 335.080,

335.100, 335.300, 335.500, 439.3401, 42 C.F.R. Part 2, 45 C.F.R. Parts 160,

164, 42 U.S.C. 1320d-2 – 1320d-8, 42 U.S.C. 290ee-3

      STATUTORY

AUTHORITY: KRS 216B.042

      NECESSITY,

FUNCTION, AND CONFORMITY: KRS 216B.042 requires the Cabinet for Health and

Family Services to promulgate administrative regulations necessary for the

proper administration of the licensure function, which includes establishing

licensure standards and procedures to ensure safe, adequate, and efficient

health facilities and health services. This administrative regulation establishes

minimum licensure requirements for the operation of behavioral health services

organizations which provide behavioral health services necessary to treat,

support, and encourage individuals with a substance use disorder, mental health

disorder, or co-occurring disorder to achieve and maintain the highest possible

level of health and self-sufficiency.

 

      Section

1. Definitions. (1) "Behavioral health professional" means:

      (a)

A psychiatrist licensed under the laws of Kentucky to practice medicine or

osteopathy, or a medical officer of the government of the United States while

engaged in the performance of official duties, who is certified or eligible to

apply for certification by the American Board of Psychiatry and Neurology, Inc;

      (b)

A physician licensed in Kentucky to practice medicine or osteopathy in

accordance with KRS 311.571;

      (c)

A psychologist licensed and practicing in accordance with KRS 319.050;

      (d)

A certified psychologist with autonomous functioning or licensed psychological

practitioner practicing in accordance with KRS 319.056;

      (e)

A clinical social worker licensed and practicing in accordance with KRS

335.100;

      (f)

An advanced practice registered nurse licensed and practicing in accordance

with KRS 314.042;

      (g)

A physician assistant licensed under KRS 311.840 to 311.862;

      (h)

A marriage and family therapist licensed and practicing in accordance with KRS

335.300;

      (i)

A professional clinical counselor licensed and practicing in accordance with

KRS 335.500; or

      (j)

A licensed professional art therapist as defined by KRS 309.130(2).

      (2)

"Behavioral health professional under clinical supervision" means a:

      (a)

Psychologist certified and practicing in accordance with KRS 319.056;

      (b)

Licensed psychological associate licensed and practicing in accordance with KRS

319.064;

      (c)

Marriage and family therapist associate as defined by KRS 335.300(3);

      (d)

Social worker certified and practicing in accordance with KRS 335.080;

      (e)

Licensed professional counselor associate as defined by KRS 335.500(4); or

      (f)

Licensed professional art therapist associate as defined by KRS 309.130(3).

      (3)

"Behavioral health services organization" means an entity licensed

under this administrative regulation to provide behavioral health services as

described in Section 6 of this administrative regulation.

      (4)

"Cabinet" means the Cabinet for Health and Family Services.

      (5)

"Certified alcohol and drug counselor" is defined by KRS 309.080(2).

      (6)

"Child with a severe emotional disability" is defined by KRS 200.503(3).

      (7)

"Community support associate" means a paraprofessional who meets the

application, training, and supervision requirements of 908 KAR 2:250.

      (8)

"Licensed assistant behavior analyst" is defined by KRS 319C.010(7).

      (9)

"Licensed behavior analyst" is defined by KRS 319C.010(6).

      (10)

"Peer support specialist" means a paraprofessional who:

      (a)

Meets the application, training, examination, and supervision requirements of

908 KAR 2:220, 908 KAR 2:230, or 908 KAR 2:240; and

      (b)

Works under the supervision of one (1) of the following:

      1.

Physician;

      2.

Psychiatrist;

      3.

Licensed psychologist;

      4.

Licensed psychological practitioner;

      5.

Licensed psychological associate;

      6.

Licensed clinical social worker;

      7.

Licensed marriage and family therapist;

      8.

Licensed professional clinical counselor;

      9.

Certified social worker;

      10.

Licensed marriage and family therapist associate;

      11.

Licensed professional counselor associate;

      12.

Licensed professional art therapist;

      13.

Licensed professional art therapist associate;

      14.

Advanced practice registered nurse;

      15.

Physician assistant; or

      16.

Certified alcohol and drug counselor.

      (11)

"Severe mental illness" means the conditions defined by KRS 210.005(2)

and (3).

      (12) "Substance use disorder" means a cluster of

cognitive, behavioral, and physiological symptoms resulting from use of a substance

which the individual continues to take despite experiencing substance-related

problems as a result, including:

      (a) Intoxication;

      (b) Withdrawal; or

      (c) A substance induced mental health disorder.

 

      Section

2. Licensure Application and Fees. (1) An applicant for initial licensure as a

behavioral health services organization shall submit to the Office of Inspector

General:

      (a)

A completed Application for License to Operate a Behavioral Health Services

Organization; and

      (b)

An accompanying initial licensure fee in the amount of $750, made payable to

the Kentucky State Treasurer.

      (2)

At least sixty (60) calendar days prior to the date of annual renewal, a

behavioral health services organization shall submit to the Office of Inspector

General:

      (a)

A completed Application for License to Operate a Behavioral Health Services

Organization; and

      (b)

An annual renewal fee of $500, made payable to the Kentucky State Treasurer.

      (3)

A behavioral health services organization:

      (a)

May provide behavioral health services as described in Section 6 of this

administrative regulation at extension locations separate from its permanent

facility; and

      (b)

Shall pay a fee in the amount of $250 per extension, submitted to the Office of

Inspector General at the time of initial licensure, renewal, or the addition of

a new extension to the organization’s license.

      (4)(a)

Name change. A behavioral health services organization shall:

      1.

Notify the Office of Inspector General in writing within ten (10) calendar days

of the effective date of a change in the organization’s name; and

      2.

Submit a processing fee of twenty-five (25) dollars.

      (b)

Change of location. A behavioral health services organization shall not change

the location where a program is operated until an Application for License to

Operate a Behavioral Health Services Organization accompanied by a fee of $100

is filed with the Office of Inspector General.

      (c)

Change of ownership.

      1.

The new owner of a behavioral health services organization shall submit to the

Office of Inspector General an Application for License to Operate a Behavioral

Health Services Organization accompanied by a fee of $750 within ten (10)

calendar days of the effective date of the ownership change.

      2.

A change of ownership for a license shall be deemed to occur if more than

twenty-five (25) percent of an existing behavioral health services organization

or capital stock or voting rights of a corporation is purchased, leased, or

otherwise acquired by one (1) person from another.

      (5)

To obtain approval of initial licensure or renew a license to operate a

behavioral health services organization, the licensee shall be in compliance

with this administrative regulation and federal, state, and local laws and

regulations pertaining to the operation of the organization.

 

      Section

3. Scope of Operation and Services. (1) A behavioral health services

organization shall:

      (a)

Provide behavioral health services, as described in Section 6 of this

administrative regulation, to meet client needs; and

      (b)

Unless an extension is granted pursuant to subsection (2) of this section, become

accredited within one (1) year of initial licensure by one (1) of the following:

      1.

Joint Commission;

      2.

Commission on Accreditation of Rehabilitation Facilities;

      3.

Council on Accreditation; or

      4.

A nationally recognized accreditation organization.

      (2)(a)

If a behavioral health services organization has not obtained accreditation in

accordance with subsection (1)(b) of this section within one (1) year of

initial licensure, the organization may request a one (1) time only extension

to complete the accreditation process.

      (b)

A request for extension shall:

      1.

Be submitted in writing to the Office of Inspector General at least sixty (60)

days prior to the date of annual renewal;

      2.

Include evidence that the organization initiated the process of becoming

accredited within sixty (60) days of initial licensure and is continuing its

efforts to obtain accreditation; and

      3.

Include an estimated timeframe by which approval of accreditation is

anticipated.

      (3)

The cabinet shall revoke a license if a behavioral health services organization

fails to meet one (1) of the following requirements:

      (a)

Become accredited in accordance with subsection (1)(b) of this section;

      (b)

Request an extension in accordance with subsection (2) of this section if accreditation

has not been obtained within one (1) year of initial licensure; or

      (c)

Maintain accreditation.

      (4)

Proof of accreditation shall be provided to the Office of Inspector General upon

receiving accreditation and at the time of annual renewal described in Section

2(2) of this administrative regulation.

 

      Section

4. Administration and Operation. (1) Licensee. The licensee shall be legally

responsible for:

      (a)

The behavioral health services organization;

      (b)

The establishment of administrative policy; and

      (c)

Ensuring compliance with federal, state, and local laws and regulations

pertaining to the operation of the organization.

      (2)

Executive director. The licensee shall establish lines of authority and

designate an executive director who:

      (a)

May serve in a dual role as the organization’s program director described in

subsection (5)(a) of this section;

      (b)

Shall be responsible for the administrative management of the organization,

including:

      1.

The total program of the organization in accordance with the organization’s

written policies; and

      2.

Evaluation of the program as it relates to the needs of each client; and

      (c)

Shall have a master's degree in business administration or a human services

field, or a bachelor's degree in a human services field, including:

      1.

Social work;

      2.

Sociology;

      3.

Psychology;

      4.

Guidance and counseling;

      5.

Education;

      6.

Religion;

      7.

Business administration;

      8.

Criminal justice;

      9.

Public administration;

      10.

Child care administration;

      11.

Christian education;

      12.

Divinity;

      13.

Pastoral counseling;

      14.

Nursing;

      15.

Public health; or

      16.

Another human service field related to working with children with severe

emotional disabilities or clients with severe mental illness.

      (3)

An executive director with a master’s degree shall have a minimum of two (2)

years of prior supervisory experience in a human services program.

      (4)

An executive director with a bachelor's degree shall have a minimum of two (2)

years of prior experience in a human services program plus two (2) years of

prior supervisory experience in a human services program.

      (5) Personnel.

A behavioral health services organization shall employ the following personnel

directly or by contract:

      (a)

A program director who shall be a:

      1.

Psychiatrist;

      2.

Physician;

      3.

Certified or licensed psychologist;

      4.

Licensed psychological practitioner;

      5.

Advanced practice registered nurse;

      6.

Licensed professional clinical counselor;

      7.

Licensed marriage and family therapist;

      8.

Licensed professional art therapist;

      9.

Licensed board certified behavior analyst; or

      10.

Licensed clinical social worker; and

      (b)

A sufficient number of personnel to provide behavioral health services, which

may include:

      1.

Behavioral health professionals;

      2.

Behavioral health professionals under clinical supervision;

      3.

Licensed behavior analysts;

      4.

Licensed assistant behavior analysts;

      5.

Case managers as described in subsections (6), (7), and (8) of this section;

      6.

Peer support specialists;

      7.

Certified alcohol and drug counselors; or

      8.

Community support associates.

      (6)

A case manager who provides targeted case management services to clients with a

substance use disorder shall:

      (a)

Have a bachelor’s degree in a human services field, including:

      1.

Psychology;

      2.

Sociology;

      3.

Social work;

      4.

Family studies;

      5.

Human services;

      6.

Counseling;

      7.

Nursing; or

      8.

Another human service degree program related to working with individuals with

substance use disorders, mental health disorders, or co-occurring disorders;

      (b)1.

Have a minimum of one (1) year of full-time employment working directly with

adolescents or adults in a human service setting after completion of a

bachelor’s degree as described in paragraph (a) of this subsection; or

      2.

Have a master’s degree in a human services field as described in paragraph (a)

of this subsection;

      (c)1.

Have successfully completed case management training approved by the Department

for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) in

accordance with 908 KAR 2:260 within six (6) months of employment; and

      2.

Have successfully completed recertification requirements approved by DBHDID in

accordance with 908 KAR 2:260 every three (3) years thereafter; and

      (d)

Be supervised by a behavioral health professional who:

      1.

Has completed case management training approved by DBHDID in accordance with

908 KAR 2:260; and

      2.

Has supervisory contact at least two (2) times per month with at least one (1)

of the contacts on an individual in person basis.

      (7)

A case manager who provides targeted case management services to clients with

co-occurring mental health or substance use disorders and chronic or complex

physical health issues shall:

      (a)

Have a bachelor’s degree in a human services field as described in subsection

(6)(a) of this section;

      (b)1.

After completion of a bachelor’s degree, have a minimum of five (5) years of

experience providing service coordination or referring clients with complex

behavioral health needs and co-occurring disorders or multi-agency involvement

to community based services; or

      2.

After completion of a master’s degree in social work, family studies, clinical

counseling, psychology, nursing, or another human service degree program

related to working with individuals with substance use disorders, mental health

disorders, or co-occurring disorders, have a minimum of two (2) years of

experience providing service coordination or referring clients with complex

behavioral health needs and co-occurring disorders or multi-agency involvement

to community based services;

      (c)1.

Have successfully completed case management training approved by the DBHDID in

accordance with 908 KAR 2:260 within six (6) months of employment; and

      2.

Have successfully completed recertification requirements approved by DBHDID in

accordance with 908 KAR 2:260 every three (3) years thereafter; and

      (d)

For a bachelor’s level case manager, be supervised by a behavioral health

professional who:

      1.

Has completed case management training approved by DBHDID in accordance with

908 KAR 2:260; and

      2.

Has supervisory contact at least three (3) times per month with at least two

(2) of the contacts on an individual in person basis.

      (8)

A case manager who provides targeted case management services to children with

a severe emotional disability or clients with a severe mental illness shall:

      (a)

Have a bachelor’s degree in a human services field as described in subsection

(6)(a) of this section;

      (b)1.

Have a minimum of one (1) year of full-time employment working directly with

individuals with behavioral health needs after completion of a bachelor’s

degree in a behavioral science field as described in subsection (6)(a) of this

section; or

      2.

Have a master’s degree in a human services field as described in subsection

(6)(a) of this section;

      (c)1.

Have successfully completed case management training approved by DBHDID in

accordance with 908 KAR 2:260 within six (6) months of employment; and

      2.

Have successfully completed recertification requirements approved by DBHDID in

accordance with 908 KAR 2:260 every three (3) years thereafter; and

      (d)

Be supervised by a behavioral health professional who:

      1.

Has completed case management training approved by DBHDID in accordance with

908 KAR 2:260; and

      2.

Has supervisory contact at least two (2) times per month with at least one (1)

of the contacts on an individual in person basis.

      (9)

Background checks.

      (a)

The executive director and all personnel of a

behavioral health services organization shall:

      1. Have a criminal record check performed upon initial hire

through the Administrative Office of the Courts or the Kentucky State Police;

      2. Not have a criminal conviction, or plea of guilty, to a:

      a. Sex crime as specified in KRS 17.500;

      b. Violent crime as specified in KRS 439.3401;

      c. Criminal offense against a minor as specified in KRS

17.500; or

      d. Class A felony; and

      3. Not be listed on the following:

      a. Central

registry established by 922 KAR 1:470;

      b. Nurse aide or home health aide abuse

registry established by 906 KAR 1:100; or

      c. Caregiver misconduct registry established by 922 KAR 5:120E

and 922 KAR 5:120.

      (b) A behavioral health services organization may use Kentucky’s

national background check system established by 906 KAR 1:190 to satisfy the

background check requirements of paragraph (a) of this subsection.

      (c) A behavioral health services organization shall perform

annual criminal record and registry checks as described in paragraph (a) of

this subsection on a random sample of at least twenty-five (25) percent of all

personnel.

      (10)

Policies. The behavioral health services organization shall establish written

policies for the administration and operation of the organization which shall

be available to all personnel and include:

      (a)

A description of the organizational structure specifying the responsibility,

function, and interrelations of each organizational unit, and the lines of

administrative and clinical authority;

      (b)

The organization’s method and procedure for storage, dispensing, and

administering a drug or biological agent;

      (c)

A client grievance procedure as described in subsection (14) of this section;

      (d)

The organization’s procedure for maintaining the confidentiality of client

records in accordance with federal, state, and local statutes and regulations;

and

      (e)

Personnel policy, including:

      1.

A job description and qualifications for each personnel category;

      2.

A plan for orientation of personnel to the policies and objectives of the

organization and on-the-job training, if necessary; and

      3.

An annual training program for staff which shall include:

      a.

Detection and reporting of abuse, neglect, or exploitation;

      b.

Behavioral management, including de-escalation training;

      c.

Physical management procedures and techniques; and

      d.

Emergency and safety procedures.

      (11)

Personnel record. A personnel record shall be kept on each staff member and

shall contain the following items:

      (a)

Name and address;

      (b)

Verification of all training and experience, including licensure,

certification, registration, or renewals;

      (c)

Verification of submission to the background check requirements of subsection

(9) of this section;

      (d)

Annual performance appraisals; and

      (e)

Employee incident reports.

      (12)

After hours services.

      (a)

The behavioral health services organization shall provide, directly or through

written agreement with another behavioral health services provider, access to

face-to-face emergency services twenty-four (24) hours per day, seven (7) days

per week.

      (b)

Emergency services shall include interventions necessary to screen, assess,

refer, and treat an individual from the point of the identified emergency or

behavioral health crisis to the point of resolution of the emergency or crisis.

      (13)

Quality assurance and utilization review.

      (a)

The behavioral health services organization shall have a quality assurance and

utilization review program designed to:

      1.

Enhance treatment and care through the ongoing objective assessment of services

provided, including the correction of identified problems; and

      2.

Provide an effective mechanism for review and evaluation of the service needs

of each client.

      (b)

The need for continuing services shall be evaluated immediately upon a change

in a client’s service needs or a change in the client’s condition to ensure

that proper arrangements have been made for:

      1.

Discharge;

      2.

Transfer; or

      3.

Referral to another service provider, if appropriate.

      (14)

Client grievance policy. The behavioral health services organization shall have

written policies and procedures governing client grievances which shall include

the following:

      (a)

Identification of a behavioral health services organization ombudsman;

      (b)

A process for filing a written client grievance;

      (c)

An appeals process with time frames for filing and responding to a grievance in

writing;

      (d)

Protection for a client from interference, coercion, discrimination, or

reprisal; and

      (e)

Conspicuous posting of the grievance procedures in a public area to inform a

client of:

      1.

His or her right to file a grievance;

      2.

The process for filing a grievance; and

      3.

The address and telephone number of the behavioral health services

organization’s and cabinet’s ombudsman.

 

      Section

5. Residential Services for Substance Use Disorders. (1) If a behavioral health

services organization licensed under this administrative regulation provides

residential services to clients with a substance use disorder, the organization

shall obtain separate licensure as an alcohol and other drug abuse treatment

program pursuant to 908 KAR 1:370.

      (2)

In addition to meeting the requirements of 908 KAR 1:370 for residential

treatment programs, a behavioral health services organization that provides

residential services for substance use disorders shall:

      (a)

Provide intensive treatment and skills building in a structured and supportive

environment;

      (b)

Assist the client in abstaining from alcohol or substance use and in entering

alcohol or drug addiction recovery;

      (c)

Provide services in a twenty-four (24) hour a day, live-in facility that offers

a planned and structured regimen of care aimed at treating individuals with

addiction or co-occurring mental health and substance use disorders;

      (d)

Assist the client in making necessary changes to enable the individual to live

drug- or alcohol-free;

      (e)

Provide services under the medical direction of a physician; and

      (f)

Provide continuous nursing services in which a registered nurse shall be:

      1.

On-site during traditional first shift hours, Monday through Friday;

      2.

Continuously available by phone after hours; and

      3. On-site as needed in follow-up to telephone consultation

after hours.

 

      Section

6. Services. (1) A behavioral health services organization licensed under this

administrative regulation shall obtain separate licensure as an alcohol and

other drug abuse treatment program pursuant to 908 KAR 1:370 if the

organization provides any of the following outpatient services for the

treatment of individuals with a substance use disorder or co-occurring disorder

in which substance use disorder is the primary diagnosis:

      (a)

Screening;

      (b)

Assessment;

      (c)

Crisis intervention;

      (d)

Mobile crisis services;

      (e)

Day treatment;

      (f)

Peer support;

      (g)

Intensive outpatient program services;

      (h)

Individual outpatient therapy;

      (i)

Group outpatient therapy;

      (j)

Family outpatient therapy;

      (k)

Collateral outpatient therapy;

      (l)

Screening, brief intervention and referral to treatment; or

      (m)

Targeted case management.

      (2)

A behavioral health services organization shall provide treatment to meet

client needs, including one (1) or more of the following:

      (a)

Screening which shall be provided by a behavioral health professional,

behavioral health professional under clinical supervision, or certified alcohol

and drug counselor to determine the:

      1.

Likelihood that an individual has a mental health, substance use, or co-occurring

disorder; and

      2.

Need for an assessment;

      (b)

Assessment which shall:

      1.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor who gathers information and engages

in a process with the client, thereby enabling the professional to:

      a.

Establish the presence or absence of a mental health, substance use, or

co-occurring disorder;

      b.

Determine the client’s readiness for change;

      c.

Identify the client’s strengths or problem areas which may affect the treatment

and recovery processes; and

      d.

Engage the client in developing an appropriate treatment relationship;

      2.

Establish or rule out the existence of a clinical disorder or service need;

      3.

Include working with the client to develop a plan of care if a clinical

disorder or service need is assessed; and

      4.

Not include psychological or psychiatric evaluations or assessments;

      (c)

Psychological testing which shall:

      1.

Be performed by a licensed psychologist, licensed psychological associate, or

licensed psychological practitioner; and

      2.

Include a psychodiagnostic assessment of personality, psychopathology,

emotionality, or intellectual disabilities, and interpretation and written

report of testing results;

      (d)

Crisis intervention which:

      1.

Shall be a therapeutic intervention for the purpose of immediately reducing or

eliminating the risk of physical or emotional harm to the client or another

individual;

      2.

Shall consist of clinical intervention and support services necessary to

provide integrated crisis response, crisis stabilization interventions, or

crisis prevention activities;

      3.

Shall be provided:

      a.

On-site at the behavioral health services organization’s facility;

      b.

As an immediate relief to the presenting problem or threat; and

      c.

In a face-to-face, one (1) on one (1) encounter;

      4.

May include verbal de-escalation, risk assessment, or cognitive therapy;

      5.

Shall be provided by a:

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision; or

      c.

Certified alcohol and drug counselor;

      6.

Shall be followed by a referral to noncrisis services, if applicable; and

      7.

May include:

      a.

Further service prevention planning, including:

      (i)

Lethal means reduction for suicide risk; or

      (ii)

Substance use disorder relapse prevention; or

      b.

Verbal de-escalation, risk assessment, or cognitive therapy;

      (e)

Mobile crisis services which shall:

      1.

Be available twenty-four (24) hours a day, seven (7) days a week, every day of

the year;

      2.

Be provided for a duration of less than twenty-four (24) hours;

      3.

Not be an overnight service;

      4.

Be a multi-disciplinary team based intervention that ensures access to acute

mental health and substance use services and supports to:

      a.

Reduce symptoms or harm; or

      b.

Safely transition an individual in an acute crisis to the appropriate, least

restrictive level of care;

      5.

Involve all services and supports necessary to provide:

      a.

Integrated crisis prevention;

      b.

Assessment and disposition;

      c.

Intervention;

      d.

Continuity of care recommendations; and

      e.

Follow-up services;

      6.

Be provided face-to-face in a home or community setting by a:

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision; or

      c.

Certified alcohol and drug counselor; and

      7.

Ensure access to a board certified or board-eligible psychiatrist twenty-four

(24) hours a day, seven (7) days a week, every day of the year;

      (f)

Day treatment which shall:

      1.

Be a nonresidential, intensive treatment program designed for children who:

      a.

Have a substance use disorder, mental health disorder, or co-occurring disorder;

      b.

Are under twenty-one (21) years of age; and

      c.

Are at high risk of out-of-home placement due to a behavioral health issue;

      2.

Consist of an organized, behavioral health program of treatment and

rehabilitative services for substance use disorder, mental health disorder, or

a co-occurring disorder;

      3.

Have unified policies and procedures that address the organization’s

philosophy, admission and discharge criteria, admission and discharge process,

staff training, and integrated case planning;

      4.

Include the following:

      a.

Individual outpatient therapy, family outpatient therapy, or group outpatient

therapy;

      b.

Behavior management and social skill training;

      c.

Independent living skills that correlate to the age and development stage of

the client; or

      d.

Services designed to explore and link with community resources before discharge

and to assist the client and family with transition to community services after

discharge;

      5.

Be provided as follows:

      a.

In collaboration with the education services of the local education authority

including those provided through 20 U.S.C. 1400 et seq. (Individuals with

Disabilities Education Act) or 29 U.S.C. 701 et seq. (Section 504 of the

Rehabilitation Act);

      b.

On school days and during scheduled school breaks;

      c.

In coordination with the child’s individual educational plan or Section 504

plan if the child has an individual educational plan or Section 504 plan;

      d.

By personnel that includes a behavioral health professional, a behavioral

health professional under clinical supervision, a certified alcohol and drug

counselor, or a peer support specialist; and

      e.

According to a linkage agreement with the local education authority that

specifies the responsibilities of the local education authority and the day treatment

provider; and

      6.

Not include a therapeutic clinical service that is included in a child’s

individualized education plan;

      (g)

Peer support which shall:

      1.

Be provided by a peer support specialist;

      2.

Be structured and scheduled nonclinical therapeutic activity with a client or

group of clients;

      3.

Promote socialization, recovery, self-advocacy, preservation, and enhancement

of community living skills; and

      4.

Be identified in the client’s plan of care;

      (h)

Intensive outpatient program services which shall:

      1. Offer a multi-modal, multi-disciplinary

structured outpatient treatment program that is more intensive than individual

outpatient therapy, group outpatient therapy, or family outpatient therapy;

      2. Be provided at least three (3) hours per day at

least three (3) days per week;

      3. Include the following:

      a. Individual outpatient therapy;

      b. Group outpatient therapy;

      c. Family outpatient therapy unless

contraindicated;

      d. Crisis intervention; or

      e. Psycho-education during which the client or

client’s family member shall be:

      (i) Provided with knowledge regarding the client’s

diagnosis, the causes of the condition, and the reasons why a particular

treatment might be effective for reducing symptoms; and

      (ii) Taught how to cope with the client’s

diagnosis or condition in a successful manner;

      4. Include a treatment plan which shall:

      a. Be individualized; and

      b. Focus on stabilization and transition to a

lower level of care;

      5. Be provided by a behavioral health professional, behavioral

health professional under clinical supervision, or a certified alcohol and drug

counselor;

      6. Include access to a board-certified or

board-eligible psychiatrist for consultation;

      7. Include access to a psychiatrist, other

physician, or advanced practice registered nurse for medication prescribing and

monitoring; and

      8. Be provided in a setting with a minimum

client-to-staff ratio of ten (10) clients to one (1) staff person;

      (i)

Individual outpatient therapy which shall:

      1.

Be provided to promote the:

      a.

Health and wellbeing of the client; or

      b.

Recovery from a substance related disorder;

      2.

Consist of:

      a.

A face-to-face encounter with the client; and

      b.

A behavioral health therapeutic intervention provided in accordance with the

client’s plan of care;

      3.

Be aimed at:

      a.

Reducing adverse symptoms;

      b.

Reducing or eliminating the presenting problem of the client; and

      c.

Improving functioning;

      4.

Not exceed three (3) hours per day; and

      5.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor;

      (j)

Group outpatient therapy which shall:

      1.

Be provided to promote the:

      a.

Health and wellbeing of the client; or

      b.

Recovery from a substance related disorder;

      2.

Consist of a face-to-face behavioral health therapeutic intervention provided

in accordance with the client’s plan of care;

      3.

Excluding multi-family group therapy, be provided in a group setting of

nonrelated individuals, not to exceed twelve (12) individuals in size. For

group outpatient therapy, a nonrelated individual means any individual who is

not a spouse, significant other, parent or person with custodial control,

child, sibling, stepparent, stepchild, step-brother, step-sister,

father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law,

sister-in-law, grandparent, or grandchild;

      4.

Focus on the psychological needs of the client as evidenced in the client’s

plan of care;

      5.

Center on goals including building and maintaining healthy relationships,

personal goals setting, and the exercise of personal judgment;

      6.

Not include physical exercise, a recreational activity, an educational

activity, or a social activity;

      7.

Not exceed three (3) hours per day per client unless additional time is

medically necessary in accordance with 907

KAR 3:130;

      8.

Ensure that the group has a deliberate focus and defined course of treatment;

      9.

Ensure that the subject of group outpatient therapy shall be related to each

client participating in the group; and

      10.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor who shall maintain individual notes

regarding each client within the group in the client’s record;

      (k)

Family outpatient therapy which shall:

      1.

Consist of a face-to-face behavioral health therapeutic intervention provided

through scheduled therapeutic visits between the therapist, the client, and at

least one (1) member of the client’s family;

      2.

Address issues interfering with the relational functioning of the family;

      3.

Seek to improve interpersonal relationships within the client’s home

environment;

      4.

Be provided to promote the health and wellbeing of the client or recovery from

a substance use disorder;

      5.

Not exceed three (3) hours per day per client unless additional time is

medically necessary in accordance with 907

KAR 3:130; and

      6.

Be provided by a behavioral health professional, a behavioral health

professional under clinical supervision, or a certified alcohol and drug

counselor;

      (l)

Collateral outpatient therapy which shall consist of a face-to-face behavioral

health consultation:

      1.

With a parent, caregiver, or person who has custodial control of a client under

the age of twenty-one (21), household member, legal representative, school

personnel, or treating professional;

      2.

Provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor; and

      3.

Provided upon the written consent of a parent, caregiver, or person who has

custodial control of a client under the age of twenty-one (21). Documentation

of written consent shall be signed and maintained in the client’s record;

      (m)

Service planning which shall be provided by a behavioral health professional,

behavioral health professional under clinical supervision, licensed behavior analyst,

or licensed assistant behavior analyst working under the supervision of a

licensed behavior analyst to:

      1.

Assist a client in creating an individualized plan for services needed for

maximum reduction of the effects of a mental health disorder;

      2.

Restore a client’s functional level to the client’s best possible functional

level; and

      3.

Develop a service plan which:

      a.

Shall be directed by the client; and

      b.

May include:

      (i)

A mental health advance directive being filed with a local hospital;

      (ii)

A crisis plan; or

      (iii)

A relapse prevention strategy or plan;

      (n)

Residential services for substance use disorders as described in Section 5 of

this administrative regulation;

      (o)

Screening, brief intervention and referral to treatment for substance use

disorders which shall:

      1.

Be an evidence-based early intervention approach for an individual with

non-dependent substance use prior to the need for more extensive or specialized

treatment;

      2.

Consist of:

      a.

Using a standardized screening tool to assess the individual for risky

substance use behavior;

      b.

Engaging a client who demonstrates risky substance use behavior in a short

conversation, providing feedback and advice;

      c.

Referring the client to therapy or other services that address substance use if

the client is determined to need additional services; and

      3.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, or a certified alcohol and drug counselor;

      (p)

Assertive community treatment for mental health disorders which shall:

      1.

Include assessment, treatment planning, case management, psychiatric services,

medication prescribing and monitoring, individual and group therapy, peer

support, mobile crisis services, mental health consultation, family support,

and basic living skills;

      2.

Be provided by a multidisciplinary team of at least four (4) professionals,

including a psychiatrist, nurse, case manager, peer support specialist and any

other behavioral health professional or behavioral health professional under

clinical supervision; and

      3.

Have adequate staffing to ensure that no caseload size exceeds ten (10)

participants per team member;

      (q)

Comprehensive community support services which shall:

      1.

Consist of activities needed to allow an individual with a mental health

disorder to live with maximum independence in the community through the use of

skills training as identified in the client’s treatment plan;

      2.

Consist of using a variety of psychiatric rehabilitation techniques to:

      a.

Improve daily living skills;

      b.

Improve self-monitoring of symptoms and side effects;

      c.

Improve emotional regulation skills;

      d.

Improve crisis coping skills; and

      e.

Develop and enhance interpersonal skills; and

      3.

Be provided by a;

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision;

      c.

Community support associate;

      d.

Licensed behavior analyst; or

      e.

Licensed assistant behavior analyst working under the supervision of a licensed

behavior analyst;

      (r)

Therapeutic rehabilitation program for an adult with a severe mental illness or

child with a severe emotional disability which shall:

      1.

Include services designed to maximize the reduction of mental illness or

emotional disability and restoration of the client’s functional level to the

individual’s best possible functioning;

      2.

Establish the client’s own rehabilitative goals within the person-centered plan

of care;

      3.

Be delivered using a variety of psychiatric rehabilitation techniques focused

on:

      a.

Improving daily living skills;

      b.

Self-monitoring of symptoms and side effects;

      c.

Emotional regulation skills;

      d.

Crisis coping skills; and

      e.

Interpersonal skills; and

      4.

Be provided individually or in a group by a:

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision; or

      c.

Peer support specialist; or

      (s)

Targeted case management services which shall:

      1.

Include services to one (1) or more of the following target groups:

      a.

An adult or a child with substance use disorder;

      b.

An adult or child with co-occurring mental health or substance use disorder and

chronic or complex physical health issues;

      c.

A child with a severe emotional disability; or

      d.

An adult with severe mental illness;

      2.

Be provided by a case manager as described in Section 4(6), (7), or (8) of this

administrative regulation; and

      3.

Include the following assistance:

      a.

Comprehensive assessment and reassessment of client needs to determine the need

for medical, educational, social, or other services. The reassessment shall be

conducted annually or more often if needed based on changes in the client’s

condition;

      b.

Development of a specific care plan which shall be based on information

collected during the assessment and revised if needed upon reassessment;

      c.

Referral and related activities, which may include:

      (i)

Scheduling appointments for the client to help the individual obtain needed

services; or

      (ii)

Activities that help link the client with medical, social, educational providers,

or other programs and services which address identified needs and achieve goals

specified in the care plan; and

      d.

Monitoring which shall be face-to-face and occur no less than once every three

(3) months to determine that:

      (i)

Services are furnished according to the client’s care plan;

      (ii)

Services in the care plan are adequate; and

      (iii)

Changes in the needs or status of the client are reflected in the care plan;

and

      e.

Contacts with the client, family members, service providers, or others are

conducted as frequently as needed to help the client:

      (i)

Access services;

      (ii)

Identify needs and supports to assist the client in obtaining services; and

      (iii)

Identify changes in the client’s needs.

      (3)

Excluding methadone-based treatment which is restricted to regulation under 908

KAR 1:340, a behavioral health services organization may employ or have an

affiliation with a physician or physicians who prescribe FDA-approved drugs for

the treatment of opioid addiction in adult patients. The behavioral health

services organization shall comply with the following requirements:

      (a)

Ensure that the physician documents in the patient’s record whether the patient

is compliant with prescribed dosing as evidenced by the results of:

      1.

A KASPER report released to the physician pursuant to KRS 218A.202(6)(e); and

      2.

Drug testing;

      (b)

Offer individual and group outpatient therapy as a service and document

monitoring of compliance with recommended non-medication therapies even if the

therapies are provided in another behavioral health setting; and

      (c)

Ensure that the physician complies with the prescribing and dispensing

standards in 201 KAR 9:270 for FDA-approved drugs used for the treatment of

opioid addiction.

      (4)

A narcotic treatment program (NTP) licensed under 908 KAR 1:340 may obtain

licensure as a behavioral health services organization if the NTP employs or

has an affiliation with a physician or physicians who prescribe FDA-approved

drugs other than methadone for the treatment of opioid addiction in adult

patients.

 

      Section 7. Plan of Care. (1) Each client receiving

direct treatment from a behavioral health services organization shall have an

individual plan of care signed by a behavioral health professional.

      (2)

A plan of care shall:

      (a)

Describe the services to be provided to the client, including the frequency of

services;

      (b)

Contain measurable goals for the client to achieve, including the expected date

of achievement for each goal;

      (c)

Describe the client’s functional abilities and limitations, or diagnosis listed

in the current edition of the American Psychiatric

Association Diagnostic and Statistical Manual of Mental Disorders;

      (d)

Specify each staff member assigned to work with the client;

      (e)

Identify methods of involving the client’s family or significant others if

indicated;

      (f)

Specify criteria to be met for termination of treatment;

      (g)

Include any referrals necessary for services not provided directly by the

behavioral health services organization; and

      (h)

The date scheduled for review of the plan.

      (3)

The client shall participate to the maximum extent feasible in the development

of his or her plan of care, and the participation shall be documented in the

client's record.

      (4)(a)

The initial plan of care shall be developed through multidisciplinary team

conferences as clinically indicated and at least thirty (30) days following the

first ten (10) days of treatment.

      (b)1.

The plan of care for individuals receiving residential services for substance

use disorder or intensive outpatient program services shall be reviewed every

thirty (30) days thereafter and updated every sixty (60) days or earlier if

clinically indicated.

      2.

The plan of care for individuals receiving outpatient services, as described in

Section 6(2)(a) through (g) and (i) through (s) of this administrative

regulation, shall be reviewed and updated every six (6) months thereafter or

earlier if clinically indicated.

      (c)

The plan of care and each review and update shall be signed by the participants

in the multidisciplinary team conference that developed it.

      (5)

A medical service, including a change of medication, a diet restriction, or a

restriction on physical activity shall be ordered by a physician or other

ordering practitioner acting within the limits of his or her statutory scope of

practice.

 

      Section

8. Client Records. (1) A client record shall be maintained for each individual

receiving services.

      (2)

Each entry shall be current, dated, signed, and indexed according to the

service received.

      (3)

Each client record shall contain:

      (a)

An identification sheet, including the client’s name, address, age, gender,

marital status, expected source of payment, and referral source;

      (b)

Information on the purpose for seeking a service;

      (c)

If applicable, consent of appropriate family members or guardians for

admission, evaluation, and treatment;

      (d)

Screening information pertaining to the mental health or substance use

disorder;

      (e)

If applicable, a psychosocial history;

      (f)

If applicable, staff notes on services provided;

      (g)

If applicable, the client’s plan of care;

      (h)

If applicable, disposition;

      (i)

If applicable, assigned status;

      (j)

If applicable, assigned therapists; and

      (k)

If applicable, a termination study recapitulating findings and events during

treatment, clinical impressions, and condition on termination.

      (4)

Ownership.

      (a)

Client records shall be the property of the organization.

      (b)

The original client record shall not be removed from the organization except by

court order or subpoena.

      (c)

Copies of a client record or portions of the record may be used and disclosed.

Use and disclosure shall be as established by subsection (6) of this section.

      (5)

Retention of records. After a client's death or discharge, the completed client

record shall be placed in an inactive file and:

      (a)

Retained for six (6) years; or

      (b)

If a minor, three (3) years after the client reaches the age of majority under

state law, whichever is the longest.

      (6)

Confidentiality and Security: Use and Disclosure.

      (a)

The organization shall maintain the confidentiality and security of client

records in compliance with the Health Insurance Portability and Accountability

Act of 1996 (HIPAA), 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and

164, as amended, including the security requirements mandated by subparts A and

C of 45 C.F.R. Part 164, or as provided by applicable federal or state law,

including 42 U.S.C. 290 ee-3, and the Confidentiality of Alcohol and Drug Abuse

Patient Records, 42 C.F.R. Part 2.

      (b)

The organization may use and disclose client records. Use and disclosure shall

be as established or required by:

      1.

HIPAA, 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and 164; or

      2.

42 U.S.C. 290 ee-3, and the Confidentiality of Alcohol and Drug Abuse Patient

Records, 42 C.F.R. Part 2.

      (c)

A behavioral health services organization may establish higher levels of

confidentiality and security than required by HIPAA, 42 U.S.C. 1320d-2 to

1320d-8, and 45 C.F.R. Parts 160 and 164, or 42 U.S.C. 290 ee-3, and the Confidentiality

of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2.

 

      Section

9. Client Rights. (1) A behavioral health services organization shall have

written policies and procedures to ensure that the rights of a client are

protected while receiving one (1) or more services as described in Section 6 of

this administrative regulation.

      (2)

A behavioral health services organization shall have written policies and

procedures governing client grievances pursuant to Section 4(14) of this

administrative regulation.

      (3)

A client shall not be unlawfully discriminated against in determining

eligibility for a service.

      (4)

During a behavioral health services organization’s intake procedures, a client

shall sign a statement which specifies that the client has the right to:

      (a)

Give informed consent to receive a service.

      1.

An adult shall sign an informed consent to receive a service.

      2.

A parent, caregiver, or person who has custodial control of a child shall sign

an informed consent for the child to receive a service;

      (b)

Have input into his or her plan of care and be informed of the plan’s content;

      (c)

Receive individualized treatment;

      (d)

File a grievance, recommendation or opinion regarding the services the client

receives;

      (e)

Give informed written consent regarding participation in a research study with

the exception of a child whose parent or guardian shall give informed written

consent;

      (f)

Confidentiality according to Section 7(6) of this administrative regulation;

      (g)

Request a written statement of the charge for a service and be informed of the

policy for the assessment and payment of fees;

      (h)

Be informed of the rules of client conduct, including the consequences for the

use of alcohol and other drugs or other infractions that may result in

disciplinary action or discharge;

      (i)

Be treated with consideration, respect, and personal dignity;

      (j)

Review his or her client record in accordance with the organization’s policy;

and

      (k)

Receive one (1) free copy of his or her client record.

      (5)

The statement of client rights as described in subsection (4) of this section

shall be:

      (a)

Provided to the client;

      (b)

If the client is a minor or incapacitated, provided to the client’s parent,

guardian, or other legal representative in addition to the client; and

      (c)

Read to the client or client’s parent, guardian, or other legal representative

if requested or if either cannot read.

      (6)

A program providing twenty-four (24) hour care shall also specify on the client

rights statement that a client has the right to:

      (a)

Vote in a political election; and

      (b)

Reasonable accommodations to afford privacy in bathing and toileting.

      (7)

If a client is restricted from exercising a client right because it is

contraindicated by the client's physical or mental condition, there shall be

documentation in the client record of the reason for the restriction and of the

explanation given to the client.

 

      Section

10. Physical Environment. (1) Accessibility. A behavioral health services

organization shall meet requirements for making buildings and facilities

accessible to and usable by individuals with physical disabilities pursuant to

KRS 198B.260 and 815 KAR 7:120.

      (2)

Fire safety. A behavioral health services organization shall be approved by the

State Fire Marshal's office prior to initial licensure or if an organization

changes location.

      (3)

Physical location and overall environment.

      (a)

A behavioral health services organization shall:

      1.

Comply with building codes, ordinances, and administrative regulations which are

enforced by city, county, or state jurisdictions;

      2.

Display a sign that can be viewed by the public that contains the facility

name, hours of operation, and a street address;

      3.

Have a publicly listed telephone number and a dedicated phone number to send

and receive faxes with a fax machine that shall be operational twenty-four (24)

hours per day;

      4.

Have a reception and waiting area;

      5.

Provide a restroom; and

      6.

Have an administrative area.

      (b)

The condition of the physical location and the overall environment shall be

maintained in such a manner that the safety and well-being of clients,

personnel, and visitors are assured.

      (4)

Prior to occupancy, the facility shall have final approval from appropriate

agencies.

 

      Section

11. License Procedures. The behavioral health services organization shall be

subject to the provisions of 902 KAR 20:008, Sections 1, 2, 5, 6, and 7.

 

      Section

12. Denial and Revocation. (1) The cabinet shall deny an Application for

License to Operate a Behavioral Health Services Organization if:

      (a)

Any person with ownership interest in the organization has had previous

ownership interest in a health care facility that had its license revoked or

voluntarily relinquished its license as the result of an investigation or

pending disciplinary action;

      (b)

Any person with ownership interest in the organization has been discontinued

from participation in the Medicaid Program due to fraud or abuse of the

program; or

      (c)

The applicant fails after the initial inspection to submit an acceptable plan

of correction or fails to submit an acceptable amended plan of correction

within the timeframes required by 902 KAR 20:008, Section 2(5).

      (2)

The cabinet shall revoke a license if it finds that:

      (a)

In accordance with KRS 216B.105(2), there has been a substantial failure by the

behavioral health services organization to comply with the provisions of this

administrative regulation;

      (b)

The behavioral health services organization fails to submit an acceptable plan

of correction or fails to submit an acceptable amended plan of correction

within the timeframes required by 902 KAR 20:008, Section 2(5);

      (c)

The behavioral health services organization fails to comply with the

requirements of Section 6(3) of this administrative regulation if the organization

employs or has an affiliation with a physician or physicians who prescribe

FDA-approved drugs, excluding methadone, to adults for the treatment of opioid

addiction; or

      (d)

The behavioral health services organization is terminated from participation in

the Medicaid Program pursuant to 907 KAR 1:671.

      (3)

The denial or revocation of a behavioral health services organization’s license

shall be mailed to the applicant or licensee, by certified mail, return receipt

requested, or by personal service. Notice of the denial or revocation shall set

forth the particular reasons for the action.

      (4)

The denial or revocation shall become final and conclusive thirty (30) days

after notice is given, unless the applicant or licensee, within the thirty (30)

day period, files a request in writing for a hearing with the cabinet.

      (5)

Urgent action to suspend a license.

      (a)

The cabinet shall take urgent action to suspend a behavioral health services

organization’s license if the cabinet has probable cause to believe that:

      1.

The continued operation of the organization would constitute an immediate

danger to the health, welfare, or safety of its patients; or

      2.

A physician employed by or affiliated with the organization may be engaged in

the improper or inappropriate prescribing or dispensing of an FDA-approved drug

for the treatment of opioid addiction.

      (b)1.

The behavioral health services organization shall be served with notice of the

hearing on the urgent suspension to be held no sooner than twenty (20) days from

the delivery of the notice.

      2.

Notice of the urgent suspension shall set forth the particular reasons for the

action.

      (c)

If the cabinet issues an urgent suspension of the behavioral health services

organization’s license pursuant to paragraph (a)2 of this subsection, the

cabinet shall refer the physician to the Kentucky Board of Medical Licensure

and appropriate law enforcement agency.

      (6)

Notice of a hearing on an urgent suspension shall be served on the behavioral

health services organization by certified mail, return receipt requested, or by

personal service.

      (7)(a)

Within five (5) working days of completion of the hearing, the cabinet’s

hearing officer shall render a written decision affirming, modifying, or

revoking the urgent suspension.

      (b)

The urgent suspension shall be affirmed if there is substantial evidence of an

immediate danger to the public health, safety, or welfare.

      (8)

The decision rendered under subsection (7) of this section shall be a final

order of the agency on the matter, and any party aggrieved by the decision may

appeal to circuit court.

      (9)

If the cabinet issues an urgent suspension, the cabinet shall take action to

revoke the behavioral health services organization’s license pursuant to

subsection (3) of this section if:

      (a)

The organization fails to attend the expedited hearing;

      (b)

The decision rendered under subsection (7) of this section affirms that there

is substantial evidence of an immediate danger to the public health, safety, or

welfare; or

      (c)

Referral to the Kentucky Board of Medical Licensure and law enforcement agency in

accordance with subsection (5)(c) of this section results in an administrative

sanction or criminal conviction against a physician employed by or affiliated

with the organization.

      (10)

Pursuant to KRS 216B.050, the cabinet may compel obedience to its lawful

orders.

 

      Section

13. Incorporation by Reference. (1) The OIG 20:430, "Application for

License to Operate a Behavioral Health Services Organization", October

2014 edition, is incorporated by reference.

      (2)

This material may be inspected, copied, or obtained, subject to applicable

copyright law, at the Office of Inspector General, 275 East Main Street,

Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (41 Ky.R.

343; Am. 1104; eff. 1346; eff. 12-17-2014.)
Read Entire Law on www.lrc.ky.gov